An integrated approach to the preservation of reproductive material in patients with oncological pathology

Abstract

Background. Every year, the number of patients who face cancer without having time to realize their reproductive function increases. In view of this, there is a growing need to develop and improve various ways to preserve fertility in this category of patients. The most common techniques are in vitro maturation of oocytes and controlled ovarian stimulation followed by vitrification of oocytes and embryos. At the same time, transvaginal puncture (TVP) has a risk of developing complications such as bleeding or an infectious process. Disorders of the vaginal microflora also increase the likelihood of inflammatory diseases. In this regard, the correction of vaginal dysbiosis is an integral part of the protocols of assisted reproductive technologies before the TVP. Aim. Development of an integrated approach to the preservation of reproductive material in patients with oncological pathology. Materials and methods. A prospective randomized study of 39 women with an identified oncological process and bacterial vaginosis was conducted. The patients were divided into 2 groups: oral probiotic was added to clindamycin therapy in group 1, and vaginal probiotic in group 2. The ovarian reserve was examined for everyone, the qualitative composition of the vaginal microflora was determined, pH-metry was performed and related specialists were consulted if necessary. Results. The patients are comparable in age and ovarian reserve. When using an oral probiotic, an improvement in the qualitative composition of the microflora was noted due to a decrease in opportunistic flora (Gardnerella vaginalis) and an increase in the number of lactobacilli. The vaginal probiotic showed comparable results, but the recurrence rate was 28%, while in group 1 it was 18%. It was noted that when taking Enterolactis Duo, the symptoms associated with chemotherapy treatment decrease. During the study, 396 oocytes were obtained, of which 212 are suitable for vitrification and fertilization. Conclusion. Currently, the development of oncofertility methods and their improvement remain one of the urgent problems. Taking an oral probiotic helps to normalize the vaginal microflora, neutralize the risks of infectious complications in TVP, reduce the likelihood of recurrence of dysbiosis and the development of adverse events associated with chemotherapy. The use of ovulation stimulation demonstrates higher rates compared to in vitro maturation. However, a combination of these procedures can be used to increase the amount of material obtained, which is subsequently used in assisted reproductive technology protocols.